Rotator cuff injury: rehab exercises and recovery

By Geoff Scott, Founder & Senior Physiotherapist, Hauora

By Geoff Scott, Senior Physiotherapist and founder of Hauora. Last updated 14 November 2026.

What is a rotator cuff injury?

The rotator cuff is a group of four muscles and their tendons that hold the ball of your shoulder in its socket and control how your arm moves. Rotator cuff injuries range from overloaded, irritated tendons (tendinopathy) to partial or full-thickness tears. Most cause pain when lifting the arm or lying on that side, and most improve with a progressive exercise programme.

At our clinic in Primrose Hill we see rotator cuff problems in swimmers, tennis and padel players, climbers and people who’ve stepped up their gym training, as well as many who’ve simply developed a painful shoulder in their forties, fifties or sixties. Patients come to us from St John’s Wood, Belsize Park, Hampstead, Camden and across north London.

Rotator cuff injury at a glance

  • The most common cause of shoulder pain: rotator cuff problems account for around 70% of shoulder pain.
  • Tears are common with age, and often painless: around 30% of people over 60, 40% over 70 and 50% over 80 have a rotator cuff tear, many without any symptoms.
  • Physio first works: in a large US study of people with full-thickness tears that weren’t caused by an injury, about 75% who followed a physiotherapy programme avoided surgery over two years.
  • Decompression surgery isn’t the answer for most: in the UK CSAW trial, subacromial decompression was no better than placebo surgery for shoulder pain.
  • Injections help in the short term only: in the UK GRASP trial of 708 people, a steroid injection eased pain at eight weeks but made no difference at 12 months.
  • Sudden weakness after a fall is different: a traumatic tear needs prompt assessment, because some do best with early repair.

Rotator cuff injury symptoms

  • Pain over the outer upper arm or top of the shoulder
  • Pain lifting your arm out to the side or overhead, often worst in the middle of the movement
  • Pain lying on that side at night
  • Pain reaching behind your back or putting on a coat
  • Weakness lifting or rotating the arm, which can point to a tear

If your shoulder is stiff in every direction, including when someone else moves it for you, a frozen shoulder is more likely. If the pain spreads down your arm with tingling, it may be coming from your neck.

Types of rotator cuff problem

  • Rotator cuff tendinopathy: the most common type. The tendons have been loaded more than they can currently tolerate, from sport, the gym, work or a change in activity. It used to be called impingement.
  • Partial-thickness tear: part of the tendon is torn. Usually treated in the same way as tendinopathy.
  • Degenerative full-thickness tear: a tear that develops gradually with age. Many respond well to rehab.
  • Traumatic tear: a tear caused by a fall, a dislocation or a heavy lift, usually with sudden weakness. These need prompt assessment.
  • Calcific tendinopathy: calcium deposits in the tendon, which can cause very severe pain.

When to get shoulder pain checked urgently

Get assessed within days if you suddenly can’t lift your arm after a fall, a dislocation or a heavy lift. Call 999 if shoulder pain, particularly on the left, comes with chest pain, breathlessness or sweating. See a doctor promptly if the shoulder is hot, red and swollen, if you have a fever, or if you have a history of cancer and new shoulder pain.

How long does a rotator cuff injury take to heal?

Most people with rotator cuff tendinopathy notice a clear improvement within 6 to 12 weeks of consistent, progressive exercise, though long-standing problems can take several months. Recovery after surgical repair is longer, usually several months before full strength returns. The most important factor is consistent work on the right exercises.

Rotator cuff rehab: what actually works

1. Calm it down without stopping

Reduce the positions that aggravate it for now, often repeated overhead work, heavy pressing and lying on that side, but keep the shoulder moving within comfort. Complete rest weakens the cuff further. A pharmacist can advise on pain relief.

2. Strengthen the cuff progressively

Exercise is the cornerstone of rotator cuff rehab. We start where your shoulder is comfortable and build load every week or two. Mild discomfort during exercise is fine if it settles within a day.

  • Isometric external rotation: with your elbow at your side bent to 90 degrees, push the back of your hand into a wall and hold for 30 to 45 seconds
  • Side-lying external rotation: lying on your good side with a light weight, rotate your forearm up towards the ceiling and lower slowly
  • Band rotations: rotating outwards and inwards against a resistance band, elbow tucked in
  • Scaption raises: lifting a light weight up and slightly forward of your body, thumbs up, to shoulder height and then higher as it improves
  • Rows and wall slides: to strengthen the muscles that control your shoulder blade

3. Work on the whole chain

Shoulder blade control, upper back mobility and, for throwers and racket players, leg and trunk strength all reduce the load the rotator cuff has to absorb. A tennis serve or a throw generates much of its power from the legs and trunk.

4. Return to sport and overhead work gradually

Overhead pressing, throwing, serving and swimming are built back in stages, increasing volume before intensity. Before a full return, rotation strength should be close to the other side and you should tolerate full sessions without a flare the next day.

5. Injections and surgery, used selectively

A steroid injection can ease severe pain enough to let you exercise, but in the GRASP trial it gave no long-term benefit. Subacromial decompression surgery performed no better than placebo surgery in the CSAW trial. Surgical repair does have a clear role for some traumatic tears in active people, and for tears that don’t respond to good rehab. We’ll refer you to a shoulder surgeon when that’s the right call.

When to see a physio about shoulder pain

Book an assessment if shoulder pain has lasted more than a couple of weeks, if it’s waking you at night, if it’s stopping you training, working or lifting, or if you’ve been told you have a tear and want to know your options. You can read more on our shoulder pain page.

How we treat rotator cuff injuries at Hauora

Your 45-minute assessment (£155) works out whether the problem is tendinopathy, a tear, a frozen shoulder or pain referred from your neck, and checks your strength and movement on each side. If a scan would change your treatment, we’ll refer you for one. The GRASP trial found that for many people, one thorough session with clear advice and a home exercise programme works as well as a longer course of supervised sessions, so we’ll be honest about how much support you need. Athletes, people with severe pain and those with demanding physical jobs usually benefit from more sessions and our strength and movement coaching. You’ll be seen by Geoff Scott or Jason Oliveira, both senior physiotherapists with elite-sport backgrounds.

Frequently asked questions

How long does a rotator cuff injury take to heal?

Most people with rotator cuff tendinopathy improve clearly within 6 to 12 weeks of progressive exercise. Long-standing problems can take several months, and recovery after surgical repair takes longer still.

Can a torn rotator cuff heal without surgery?

The tear itself may not heal, but the pain and function usually improve without surgery. In a large study of full-thickness tears that weren’t caused by an injury, about 75% of people who followed a physiotherapy programme avoided surgery over two years.

What are the best rotator cuff exercises?

Progressive strengthening is key: isometric holds to start, then external rotation with a weight or band, scaption raises, rows and shoulder blade exercises, building the load every week or two.

Should I rest a rotator cuff injury?

Ease off the positions that aggravate it, but don’t stop moving it. Complete rest weakens the rotator cuff further. Gentle movement and progressive exercise help it recover.

Is a steroid injection good for rotator cuff pain?

It can help in the short term. In the UK GRASP trial, a steroid injection eased pain and improved function at eight weeks but made no difference at 12 months. It’s most useful when pain is stopping you doing your exercises.

How do I know if I’ve torn my rotator cuff?

Weakness lifting or rotating your arm, especially if it came on suddenly after a fall or a heavy lift, suggests a tear. A physio can test this clinically, and an ultrasound or MRI scan can confirm it if the result would change your treatment.

Related reading: shoulder injury rehab without surgery, tennis elbow treatment and exercises and return-to-sport testing.

Rotator cuff physio in Primrose Hill, St John’s Wood and Belsize Park

If shoulder pain is affecting your sleep, work or sport, book an assessment at Hauora, an independent physiotherapy clinic at 44 Gloucester Avenue, Primrose Hill, London NW1 8JD. We’re close to Chalk Farm and Camden Town stations and easy to reach from St John’s Wood, Belsize Park, Swiss Cottage, Hampstead, Regent’s Park, Marylebone, Kentish Town and Maida Vale. Book online at hauora.com/book or call 020 4541 8924.

Finding us: Hauora is based inside the At The Core building, but we’re a separate business from At The Core. We share the building and the phone number, so when you call, please ask for Hauora.

This article is general information, not a diagnosis. If you’re injured or unwell, see a doctor or physiotherapist.

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